Using lean six sigma to improve throughput efficiency at tertiary care eye hospital

Objective: To determine the impact of Lean Sigma (LS) on waiting time of patients at different stations of outpatient department (OPD), pre-surgical area and operation room (OR). Methods: In this prospective quality study Define, Measure, Analyse, Improve and Control (DMAIC) model of lean sigma was used for improvement. Lead time of patients during measure phase of DMAIC was assessed using time motion study. This lead time was used as control to compare lead time after LS initiatives. Lead time is the total time taken by one patient in Eye OPD. Lead time include cycle time (time taken to perform procedure) and waiting time at each station. It is calculated using value stream map at every station of OPD. Reduction in median lead time of patients in OPD and OR was used as measure of improvement. Result: Median lead time measured before implementation of LS initiatives was 86 minutes in Eye OPD. There was 19% reduction in lead median time in Eye OPD. This reduction in lead time generated capacity in OPD for new patients. The median time in pre surgical clinic was reduced from 1hr 22 minutes to 33 minutes. Conclusions: Lean approaches can have an immediate and sustained impact on patient’s waiting time in OPD, presurgical area and OT with no negative effect on quality. Lean intervention generated consistent results independent of personnel during the busiest months of the year at a tertiary care eye hospital in North India.